Premature ovarian failure in women with juvenile idiopathic arthritis (JIA)

OBJECTIVE: To examine the effect of longstanding juvenile idiopathic arthritis (JIA) on menstrual irregularity and the incidence of premature ovarian failure in women. METHODS: Women with longstanding JIA who had abnormal or absent menstrual cycles had their circulating levels of gonadotrophins measured to check for the presence of ovarian failure. Disease demographics and subsets, function, age at onset of menstrual irregularity, previous medical intervention, concurrent diseases and history of pregnancy/delivery were documented. RESULTS: 177/187 (95%) of female adults with JIA who were identified and contacted, participated in the study. The average age at review was 35.4 years (19-78) with average disease duration of 28.7 years. 47.4% of all patients had clinically active arthritis. 44.6% of all patients had severe disability (HAQ score > 1.5). Six patients had premature ovarian failure unrelated to medication use, comprising 3.4% of the females in the study, compared to an expected incidence of 1% in the general population (p < 0.01). In addition, three (1.7%) of these had onset of symptoms before age 30, compared to an expected incidence of 0.1% in the general population (p < 0.01). The average maternal age at first delivery in women with JIA (27.2 years) was higher than the general population (23.5 years). CONCLUSION: Idiopathic premature ovarian failure was more commonly found in individuals with juvenile idiopathic arthritis. In addition a small number of patients had iatrogenic premature ovarian failure related to chlorambucil use.